High-Need Patients' Goals and Goal Progress in a Veterans Affairs Intensive Outpatient Care Program.
Veterans
patient goal
patient-centered medical home
primary care redesign
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
16
08
2018
accepted:
26
02
2019
revised:
02
01
2019
pubmed:
30
5
2019
medline:
5
11
2020
entrez:
30
5
2019
Statut:
ppublish
Résumé
Healthcare systems nationwide are implementing intensive outpatient care programs to optimize care for high-need patients; however, little is known about these patients' personal goals and factors associated with goal progress. To describe high-need patients' goals, and to identify factors associated with their goal progress DESIGN: Retrospective cohort study PARTICIPANTS: A total of 113 high-need patients participated in a single-site Veterans Affairs intensive outpatient care program. Two independent reviewers examined patients' goals recorded in the electronic health record, categorized each goal into one of three domains (medical, behavioral, or social), and determined whether patients attained goal progress during program participation. Logistic regression was used to determine factors associated with goal progress. The majority (n = 72, 64%) of the 113 patients attained goal progress. Among the 100 (88%) patients with at least one identified goal, 58 set goal(s) in the medical domain; 60 in the behavioral domain; and 52 in the social domain. Within each respective domain, 41 (71%) attained medical goal progress; 34 (57%) attained behavioral goal progress; and 32 (62%) attained social goal progress. Patients with mental health condition(s) (aOR 0.3; 95% CI 0.1-0.9; p = 0.03) and those living alone (aOR 0.4; 95% CI 0.1-1.0; p = 0.05) were less likely to attain goal progress. Those with mental health condition(s) and those who were living alone were least likely to attain goal progress (interaction aOR 0.1 compared to those with neither characteristic; 95% CI 0.0-0.7; p = 0.02). Among high-need patients participating in an intensive outpatient care program, patient goals were fairly evenly distributed across medical, behavioral, and social domains. Notably, individuals living alone with mental health conditions were least likely to attain progress. Future care coordination interventions might incorporate strategies to address this gap, e.g., broader integration of behavioral and social service components.
Sections du résumé
BACKGROUND
Healthcare systems nationwide are implementing intensive outpatient care programs to optimize care for high-need patients; however, little is known about these patients' personal goals and factors associated with goal progress.
OBJECTIVE
To describe high-need patients' goals, and to identify factors associated with their goal progress DESIGN: Retrospective cohort study PARTICIPANTS: A total of 113 high-need patients participated in a single-site Veterans Affairs intensive outpatient care program.
MAIN MEASURES
Two independent reviewers examined patients' goals recorded in the electronic health record, categorized each goal into one of three domains (medical, behavioral, or social), and determined whether patients attained goal progress during program participation. Logistic regression was used to determine factors associated with goal progress.
RESULTS
The majority (n = 72, 64%) of the 113 patients attained goal progress. Among the 100 (88%) patients with at least one identified goal, 58 set goal(s) in the medical domain; 60 in the behavioral domain; and 52 in the social domain. Within each respective domain, 41 (71%) attained medical goal progress; 34 (57%) attained behavioral goal progress; and 32 (62%) attained social goal progress. Patients with mental health condition(s) (aOR 0.3; 95% CI 0.1-0.9; p = 0.03) and those living alone (aOR 0.4; 95% CI 0.1-1.0; p = 0.05) were less likely to attain goal progress. Those with mental health condition(s) and those who were living alone were least likely to attain goal progress (interaction aOR 0.1 compared to those with neither characteristic; 95% CI 0.0-0.7; p = 0.02).
CONCLUSIONS
Among high-need patients participating in an intensive outpatient care program, patient goals were fairly evenly distributed across medical, behavioral, and social domains. Notably, individuals living alone with mental health conditions were least likely to attain progress. Future care coordination interventions might incorporate strategies to address this gap, e.g., broader integration of behavioral and social service components.
Identifiants
pubmed: 31140094
doi: 10.1007/s11606-019-05010-w
pii: 10.1007/s11606-019-05010-w
pmc: PMC6667543
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1564-1570Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR003142
Pays : United States
Références
JAMA. 2017 Jul 4;318(1):25-26
pubmed: 28594991
Musculoskeletal Care. 2017 Dec;15(4):295-303
pubmed: 27976535
JAMA Intern Med. 2017 Feb 1;177(2):166-175
pubmed: 28027338
J Gen Intern Med. 2017 Apr;32(4):392-397
pubmed: 28243870
Med Care. 2013 Apr;51(4):368-73
pubmed: 23269113
JAMA. 1996 Feb 14;275(6):474-8
pubmed: 8627970
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
J Am Geriatr Soc. 2016 Jul;64(7):1503-9
pubmed: 27305428
Issue Brief (Commonw Fund). ;43:1-20
pubmed: 27959480
Am J Hosp Palliat Care. 2011 Feb;28(1):31-4
pubmed: 20543162
Healthc (Amst). 2018 Dec;6(4):231-237
pubmed: 29102480
Med Care. 2018 Jan;56(1):19-24
pubmed: 29087980
Am J Hosp Palliat Care. 2008 Dec-2009 Jan;25(6):501-11
pubmed: 19106284
J Am Geriatr Soc. 1995 May;43(5):553-62
pubmed: 7537289
Disabil Rehabil. 2015;37(7):563-70
pubmed: 24999905
Arch Intern Med. 2011 Mar 14;171(5):460-6
pubmed: 21403043
Am J Public Health. 1992 Mar;82(3):401-6
pubmed: 1536356
West J Nurs Res. 2017 Nov;39(11):1447-1458
pubmed: 27837160
JAMA. 1997 Nov 19;278(19):1608-12
pubmed: 9370508
N Engl J Med. 2016 Dec 29;375(26):2511-3
pubmed: 28029924
Issue Brief (Commonw Fund). 2015 Oct;31:1-19
pubmed: 26591906
JAMA. 2015 Oct 13;314(14):1445-6
pubmed: 26378889
Soc Sci Med. 2002 Aug;55(4):673-9
pubmed: 12188471
JAMA. 2010 Nov 3;304(17):1936-43
pubmed: 21045100
Chronic Illn. 2014 Mar;10(1):50-9
pubmed: 23838837
J Epidemiol Community Health. 2006 Jun;60(6):468-75
pubmed: 16698975
BMJ. 2003 Apr 19;326(7394):877-9
pubmed: 12702627
J Am Geriatr Soc. 1997 Apr;45(4):526-7
pubmed: 9100727
JAMA. 2000 Nov 15;284(19):2476-82
pubmed: 11074777
Am J Public Health. 1981 Aug;71(8):802-9
pubmed: 7258441
J Gen Intern Med. 2017 Dec;32(12):1377-1386
pubmed: 28924747
AJS. 1981 Jul;87(1):48-74
pubmed: 7258475
Int J Epidemiol. 1994 Feb;23(1):91-7
pubmed: 8194929
N Engl J Med. 2012 Mar 1;366(9):777-9
pubmed: 22375966